Pathophysiology of medication overuse headache: Insights and hypotheses from preclinical studies
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Introduction: Medication overuse headache (MOH) is a clinical concern in the management of migraine headache. MOH arises from the frequent use of medications used for the treatment of a primary headache. Medications that can cause MOH include opioid analgesics as well as formulations designed for the treatment of migraine, such as triptans, ergot alkaloids, or drug combinations that include caffeine and barbiturates. Literature review: Gathering evidence indicates that migraine patients are more susceptible to development of MOH, and that prolonged use of these medications increases the prognosis for development of chronic migraine, leading to the suggestion that similar underlying mechanisms may drive both migraine headache and MOH. In this review, we examine the link between several mechanisms that have been linked to migraine headache and a potential role in MOH. For example, cortical spreading depression (CSD), associated with migraine development, is increased in frequency with prolonged use of topiramate or paracetamol. Conclusions: Increased CGRP levels in the blood have been linked to migraine and elevated CGRP can be casued by prolonged sumatriptan exposure. Possible mechanisms that may be common to both migraine and MOH include increased endogenous facilitation of pain and/or diminished diminished endogenous pain inhibition. Neuroanatomical pathways mediating these effects are examined.
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In these patients, the main unresolved problem is excessive use of drugs for acute treatment and overall deterioration in quality of life, so headache symptoms should be considered as part of the issue as a whole.
“In these patients, the main unresolved problem is the excessive use of drugs for the acute treatment and the overall deterioration experienced in their quality of life, so the headache symptoms should be considered as part of the issue as a whole [2, 6, 7].”
From Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial (2012) · cites this paper as [2]
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- Authors
- Meng, I. D., Dodick, D., Ossipov, M. H., & Porreca, F.
- Affiliations
- University of New England (US)
- Mayo Clinic in Arizona (US)
- University of Arizona (US)
- Corresponding author
- Porreca, Frank
- Venue
- Cephalalgia
- Publisher
- SAGE Publications
- Published
- 2011-03-28
- Volume
- 31
- Issue
- 7
- Pages
- 851-860
- ISSN
- 0333-1024 (ISSN-L)
- 1468-2982
- PMC
- PMC5697138
- OpenAlex
- W1973686203
- Cited by
- 70
- References
- 101
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 7 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 5 · 2013: 6 · 2012: 6
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cephalalgia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (DA029112, R01DA021193)
- National Institute of Neurological Disorders and Stroke (R01NS069572)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- medication overuse headache, migraine, pathophysiology, cortical spreading depression, topiramate, paracetamol, sumatriptan, calcitonin gene-related peptide, chronic migraine, opioid analgesics, triptans, caffeine, barbiturates, endogenous pain inhibition
- MeSH terms
- Analgesics, Opioid, Humans, Migraine Disorders, Tryptamines, Headache Disorders, Secondary
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